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Transnasal endoscopic management of angiofibroma extending to pterygopalatine and infratemporal fossae

Published online by Cambridge University Press:  19 April 2011

S M El Morsy  and
Y W Khafagy
S M El Morsy*
Affiliation:
Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Egypt
Y W Khafagy
Affiliation:
Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Egypt
*
Address for correspondence: Dr Shawky Mahmoud El Morsy, Assistant Professor of Otolaryngology, Mansoura University, Faculty of Medicine Otorhinolaryngology Department, Elgomhoria street, Mansoura, PO 35516, Egypt-Dakhlia Fax: +20502267016 E-mail: shawky_morsy2003@yahoo.com
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Abstract

Introduction:

Surgical approaches to the pterygopalatine and infratemporal fossae are complex and cause significant morbidity. The commonest benign tumour to extend to the pterygopalatine and infratemporal fossae is angiofibroma.

Patients and methods:

This prospective study included 15 male patients aged 12–27 years with recurrent, severe epistaxis. After computed tomography and magnetic resonance imaging, a modified Wormald and Robinson's two-surgeon approach was used. Follow up, with endoscopy and magnetic resonance imaging, ranged from two to five years.

Results:

Twelve patients were cured (endoscopically and radiologically). Three patients suffered recurrence, one each in the lateral sphenoid wall, pterygoid canal and infratemporal fossa. Revision surgery was performed, but one patient suffered another recurrence (lateral sphenoid wall with cavernous sinus infiltration) and was referred for gamma knife surgery.

Conclusion:

This endoscopic two-surgeon technique is an excellent approach for managing angiofibroma extending to the pterygopalatine and infratemporal fossae. Our modification markedly decreased morbidity by avoiding septum opening and sublabial incision, and by enabling better haemostasis (via maxillary artery control). Recurrence may be minimised by careful examination of the lateral sphenoid wall, pterygoid canal and infratemporal fossa pterygoid muscles.

Keywords

Endoscopic approachPtyrgopalatine fossaInfratemporal fossaAngiofibroma
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 7 , July 2011 , pp. 701 - 705
Copyright
Copyright © JLO (1984) Limited 2011

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Footnotes

Presented at Rhinology World Conference, 15–19 April 2009, Philadelphia, Pennsylvania, USA

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